Provider Demographics
NPI:1205574936
Name:KORIS BEHAVIORAL CENTERS, INC.
Entity type:Organization
Organization Name:KORIS BEHAVIORAL CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODABAKHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-415-9222
Mailing Address - Street 1:452 S. CALIFORNIA AVE
Mailing Address - Street 2:#7
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:452 S. CALIFORNIA AVE
Practice Address - Street 2:#7
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:818-939-2471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty